I am a professional midwife in California proving community-based care for planned home birth (PHB). I also have been pre-diabetic since the birth of my second child in my early twenties. With a low-glycemic diet, exercise and monitoring my BG I have avoided any progression to a disease state. My last A1C was 5.0. I’m now in my 60s, so what I am doing has worked pretty well for the last 4 decades.
As for your question about midwives testing (or not testing) for GDM, the short answer is some do and some don’t. The extreme over-medicalization of normal pregnancy by the obstetrical profession has resulted in a general skepticism of all testing among midwives and those women who seek out independent mfry care for a PHB.
However, most state-licensed midwives like myself provide care under a formal standard of care that includes offering the customary obstetrical options, including GDM screening. Assuming appropriate counseling and informed consent, childbearing women are free to decline any type of testing they object to or do not believe useful. About 30% will decline all testing, including GDM screening, genetic testing and ultrasound.
That said, I have found that PHB mothers who resist going to a lab and drinking orange glucola will jump at the chance to take a glucometer home and do fasting and PP blood glucose for themselves. By having women self-monitor their BG at home, I can tell whether they are having abnormal blood sugars when they consume their regular meals in the context of their regular life.
I think this is a superior solution, as many women with impaired carbohydrate metabolism will flunk the one hour (50 gm load), only to subsequently pass the 3-hr GTT. The current advise in the medical literature is to tell these moms they don’t have to worry, they don’t have GDM and they don’t have to watch their diet. Newer research and my own professional experiences tells me that is not true - high BG at one hour is irrefutable evidence of impaired carbohydrate metabolism. It is a lost opportunity when the medical profession does not use this information to preemptively educate these patients about their potential problems and the methods and resources available to them to avoid or greatly delay the development of diabetes.
I think it is both practical and valuable to counsel these women to continue monitoring BG during pregnancy and to change their own diet and the way the rest of their family eats. This improved diet is preventative for the mother and her fetus, as well as her whole family, who obviously share the same genes and propensity of eventually developing some form of ICM or frank states of diabetes. This pro-active form of education on dietary prevention is one of the best ways to reduce both diabetes and obesity. Personally and professionally, I continue to believe that this kind of teaching is the best kind of preventive healthcare.
Having just discovered the Tudiabetes site, I will spread the word to other midwives and suggest they tell their clients to visit this site to check out the many wonder sources of information and opportunities to connect with others like themselves.